Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 641 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 25 25 38.244445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 25 25 38.244445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.066667 $153.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 54.871428 $2743.5800 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 6 55.285714 $3212.6600 $58.1100
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Subtotal (Total Children Is Unduplicated) 12 14 113.223809 $6109.5800 $53.9600
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 82 137.142857 $6857.1500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 6.000000 $150.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 98 108 89.994443 $4499.7200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 51 58 53.155556 $2657.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 20.166667 $1008.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 57 61 53.849999 $2692.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 150 184 1415.990475 $76463.5700 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 23 186.714285 $15183.6300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.142857 $9.3100 $65.1400
PHY -97110 PT SESSION BY LICENSED PT 22 27 237.428569 $19307.7300 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 27 217.607143 $17695.8400 $81.3200
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Subtotal (Total Children Is Unduplicated) 297 602 2418.192851 $146525.5500 $60.5900
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Total 641 2569.661105 $152635.1300 $59.4000
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Number of Children (Unduplicated) With at Least One Authorization 327